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<html dir="ltr" xmlns="http://www.w3.org/1999/xhtml">
<%@include file="/WEB-INF/taglibs/common/taglibs.jsp" %>

<head>
    <title><spring:message code="sp.reprint_check.title"/></title>
    <meta content="text/html; charset=utf-8" http-equiv="Content-Type"/>
    <link rel="stylesheet" href="<c:url value="/css/styles.css"/>"/>
    <script src="<c:url value="/javascripts/common.js"/>"></script>
</head>

<body>
<div class="page">
    <%@include file="../../top_menu.jsp" %>
    <table width="100%">
        <tr>
            <td>
                <c:import url="/WEB-INF/jsp/menu/checks_menu.jsp"/>
            </td>
        </tr>
      
        <tr>
            <td>
                <%@include file="/WEB-INF/jsp/include/messages.jsp" %>
                <br/>
            </td>
        </tr>
        
   <tr> 
      
      <td>
<form id="role" method="post">
              <%@include file="../common/search_checks.jsp" %>
          <p> <strong><font color="#FF00FF">No Record Found.</font></strong></p>
          <p>If no results were found matching the request then please fill out 
            the following form with as much information as possible.</p>  
          <table width="960" height="287" class="formTable">
            <tbody>
              <tr class="formHeader"> 
                <td colspan="7">Enter Check Detail</td>
              </tr>
              <tr> 
                <td width="151" class="label"><label for="label3" class="inline">Check 
                  Number<span class="req"> <font color="#FF00FF">*</font></span></label></td>
                <td width="147"><input name="postal_service2" size="21" type="text" /> 
                </td>
                <td width="116" class="label"><label for="label" class="inline">Order 
                  ID <font color="#FF00FF">*</font></label></td>
                <td width="148"><input name="postal_tracking_number2" size="21" type="text" /> 
                </td>
                <td width="154" class="label"><label for="label" class="inline"> 
                  Transaction ID <font color="#FF00FF">*</font></label></td>
                <td width="147"><input name="mailing address2" size="21" type="text" /> 
                </td>
              </tr>
              <tr> 
                <td height="30" class="label"> <label for="label" class="inline"> 
                  Date of Printing <font color="#FF00FF">*</font> </label></td>
                <td><input name="zip_code2" size="21" type="text" /></td>
                <td class="label"><label for="label" class="inline">Order Date 
                  <font color="#FF00FF">*</font> </label></td>
                <td><input name="mailing_city2" size="21" type="text" /></td>
                <td class="label"><label for="label" class="inline"> Originator 
                  Name <font color="#FF00FF">*</font></label></td>
                <td><input name="date_of _posting22" size="21" type="text" /> 
                </td>
              </tr>
              <tr> 
                <td class="label">Date Picked up by Customer <font color="#FF00FF">*</font></td>
                <td><input name="account_no22" size="21" type="text" /></td>
                <td class="label"><label for="label3" class="inline">Batch ID 
                  <font color="#FF00FF">*</font> </label></td>
                <td><input name="date_of _posting23" size="21" type="text" /></td>
                <td class="label"><label for="label" class="inline"> Taxpayer 
                  Balance Amount<font color="#FF00FF"> *</font></label></td>
                <td><input name="date_of _posting2" size="21" type="text" /> </td>
              </tr>
              <tr> 
                <td class="label"><label for="label3" class="inline">Taxpayer 
                  SSN <font color="#FF00FF">*</font></label></td>
                <td width="147"><input name="postal_service2" size="21" type="text" /> 
                </td>
                <td class="label"><label for="label" class="inline">Taxpayer First 
                  Name <font color="#FF00FF">*</font></label></td>
                <td width="148"><input name="postal_tracking_number2" size="21" type="text" /> 
                </td>
                <td class="label"><label for="label" class="inline"> Taxpayer 
                  Middle Name <font color="#FF00FF">*</font></label></td>
                <td width="147"><input name="mailing address2" size="21" type="text" /> 
                </td>
              </tr>
              <tr> 
                <td class="label"><label for="label" class="inline"> Taxpayer 
                  Last Name <font color="#FF00FF">*</font></label></td>
                <td><input name="zip_code2" size="21" type="text" /></td>
                <td class="label"><label for="label" class="inline">Spouse First 
                  Name </label></td>
                <td><input name="mailing_city2" size="21" type="text" /></td>
                <td class="label"><label for="label" class="inline"> Spouse Middle 
                  Name </label></td>
                <td><input name="date_of _posting22" size="21" type="text" /> 
                </td>
              </tr>
              <tr> 
                <td height="36" class="label">Spouse Last Name </td>
                <td><input name="zip_code2" size="21" type="text" /></td>
                <td class="label"><label for="label" class="inline">Spouse SSN 
                  </label></td>
                <td><input name="mailing_city2" size="21" type="text" /></td>
                <td class="label"><label for="label" class="inline">Status <font color="#FF00FF">*</font></label></td>
                <td><input name="mailing_city2" size="21" type="text" /></td>
              </tr>
              <tr> 
                <td class="label">Amount <font color="#FF00FF">*</font></td>
                <td><input name="zip_code2" size="21" type="text" /></td>
                <td class="label">&nbsp;</td>
                <td>&nbsp;</td>
                <td class="label">&nbsp;</td>
                <td>&nbsp;</td>
              </tr>
            </tbody>
          </table>
          <p>&nbsp;</p>
        <table width="1039" class="formTable">
          <tbody>
              <tr class="formHeader"> 
                <td colspan="7">Report Problem with Blank Checks</td>
              </tr>
              <tr> 
                
              <td width="137" height="29" class="label">
<label for="service" class="inline">Postal Service 
                  <font color="#FF00FF">*</font> </label></td>
                <td width="165"><input name="postal_service5" size="21" type="text" /> </td>
                <td width="192" class="label"><label for="tracking_number" class="inline">Postal 
                  Tracking Number <font color="#FF00FF">*</font><span class="req"> 
                  </span></label></td>
                <td width="226"><input name="postal_tracking_number" size="21" type="text" /> 
                </td>
                <td width="130" class="label"><label for="address" class="inline">Mailing 
                  Address <font color="#FF00FF">*</font></label></td>
                <td width="161"><input name="mailing address" size="21" type="text" /> </td>
              </tr>
              <tr> 
                
              <td height="30" class="label">
<label for="zip_code" class="inline">Postal 
                  Code <font color="#FF00FF">*</font></label></td>
                <td><input name="zip_code" size="21" type="text" /></td>
                <td class="label"><label for="label2" class="inline">City <font color="#FF00FF">*</font></label></td>
                <td><input name="mailing_city" size="21" type="text" /></td>
                <td class="label"><label for="country" class="inline">Country<span class="req"> 
                  <font color="#FF00FF">*</font> </span></label></td>
                <td> <select name="mailing_country" style="width:150px;">>
                    <option value="pakistan" selected="selected">Pakistan</option>
                    <option value="united_states">United States</option>
                    <option value="india">India</option>
                  </select></td>
              </tr>
              <tr> 
                <td class="label"><label for="account_number" class="inline">Reason 
                  <font color="#FF00FF">*</font> </label></td>
                <td><select name="select2" style="width:150px;">
                    <option value="upside" selected="selected">Printed upside 
                    down</option>
                    <option value="twice">Printed twice</option>
                    <option value="backside">Printed on backside</option>
                    <option value="burnt">Partialy /fully burnt</option>
                    <option value="other">Other - please type reason</option>
                  </select></td>
                <td class="label"><label for="account_number" class="inline">Reason 
                  Detail <font color="#FF00FF">*</font></label></td>
                <td><textarea name="account_no2" cols="30" rows="5"></textarea></td>
                <td class="label"><label for="date" class="inline">Date of Posting 
                  <font color="#FF00FF">*</font> <span class="req"> </span></label></td>
                <td><input name="date_of _posting" size="21" type="text" /> </td>
              </tr>
              <tr> 
                
              <td height="31" class="label">
<label for="account_number" class="inline">Check 
                  Image <font color="#FF00FF">*</font></label></td>
                <td colspan="2"><input type="file" name="logo23" id="logo2" /></td>
                <td>&nbsp;</td>
                <td class="label">&nbsp;</td>
                <td>&nbsp;</td>
              </tr>
              <tr> 
                <td class="label">&nbsp;</td>
                <td>&nbsp;</td>
                <td class="label">&nbsp;</td>
                <td>&nbsp;</td>
                <td class="label">&nbsp;</td>
                <td>&nbsp;</td>
              </tr>
              <tr> 
                <td><input name="submit34" type="submit" class="ui-button ui-state-default ui-corner-all" value="Submit" /></td>
              </tr>
            </tbody>
          </table>
          <p>&nbsp;</p>
          
        <table width="1067" class="formTable">
          <tbody>
            <tr class="formHeader"> 
              <td colspan="7">Report Problems with Printed Checks</td>
            </tr>
            <tr> 
              <td width="115" class="label"><label for="service" class="inline">Message 
                Title <font color="#FF00FF">*</font> <span class="req"> </span></label></td>
              <td width="255"><input name="postal_service3" size="21" type="text" /> 
              </td>
              <td width="123" class="label"><label for="tracking_number" class="inline">Message<span class="req"> 
                <font color="#FF00FF">*</font> </span></label></td>
              <td width="218"><textarea name="textarea4" cols="30"  rows="5"></textarea> 
              </td>
              <td width="113" class="label"><label for="address" class="inline">Description</label></td>
              <td width="215"><textarea name="textarea4" cols="30"  rows="5"></textarea> 
              </td>
            </tr>
            <tr> 
              <td class="label">Check Image <font color="#FF00FF">*</font></td>
              <td><input type="file" name="logo22" id="logo22" /></td>
              <td class="label">Reason <font color="#FF00FF">*</font></td>
              <td><select name="select4" style="width:150px;">
                  <option value="stolen" selected="selected">Stolen Checks</option>
                  <option value="missing">Missing Checks</option>
                  <option value="lost">Lost Checks</option>
                  <option value="burnt">Partialy /fully damage check</option>
                  <option value="dup">Duplicate or Double Payment</option>
                  <option value="miss">Miss Printed or Incorrect Amount</option>
                  <option value="theft">Identity Theft</option>
                  <option value="other">Other - please type reason</option>
                </select></td>
              <td class="label">Reason Detail <font color="#FF00FF">*</font></td>
              <td> <textarea name="textarea4" cols="30"  rows="5"></textarea></td>
            </tr>
            <tr> 
              <td class="label">Police Report<font color="#FF00FF"> *</font></td>
              <td><input type="file" name="logo2" id="logo23" /></td>
              <td class="label"><label for="zip_code" class="inline">Inform Bank 
                by</label></td>
              <td> <select name="select4" style="width:150px;">
                  <option value="1" selected="selected">E-mail</option>
                  <option value="2">Phone</option>
                  <option value="3">Fax</option>
                  <option value="4">Text Message</option>
                </select></td>
              <td class="label">&nbsp;</td>
              <td>&nbsp;</td>
            </tr>
            <tr> 
              <td height="27"> <input name="submit33" type="submit" class="ui-button ui-state-default ui-corner-all" value="Stop Payment" /></td>
            </tr>
          </tbody>
        </table>
          <p>&nbsp;</p>
          <table width="985" class="formTable">
            <tbody>
              <tr class="formHeader"> 
                <td colspan="7">File Upload</td>
              </tr>
              <tr> 
                <td width="117" class="label"><label for="service" class="inline">Title 
                  <font color="#FF00FF">*</font> <span class="req"> </span></label></td>
                <td width="255"><input name="postal_service" size="21" type="text" /> 
                </td>
                <td width="102" class="label"><label for="tracking_number" class="inline"><span class="req">Description<font color="#FF00FF"> 
                  *</font> </span></label></td>
                <td width="250"><textarea name="textarea" cols="30"  rows="5"></textarea> 
                </td>
                <td width="45" class="label"><label for="address" class="inline">Tags</label></td>
                <td width="188"><input name="postal_service4" size="21" type="text" /> 
                </td>
              </tr>
              <tr> 
                <td class="label">File <font color="#FF00FF">*</font></td>
                <td><input type="file" name="logo2" id="logo23" /></td>
                <td class="label">&nbsp;</td>
                <td>&nbsp;</td>
                <td class="label">&nbsp;</td>
                <td>&nbsp;</td>
              </tr>
              <tr> 
                <td><input name="submit3" type="submit" class="ui-button ui-state-default ui-corner-all" value="Upload" /></td>
              </tr>
            </tbody>
          <p>&nbsp;</p>
      </form></td>
    </tr>
  </tbody>
</table>

<div class="contentArea">
    </div>
</div>
<%@include file="/WEB-INF/jsp/include/footer.jsp" %>
</body>